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Nursing 280 > Unit 2 > Flashcards

Unit 2 Flashcards

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1
Q

Early signs & symptoms of Hypothyroidism

A

Fatigue, cold intolerance, wt gain, dry skin, brittle hair and nails, high DBP

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2
Q

Late signs & symptoms of Hypothyroidism

A

Slow speech, hoarse, loss of outer 1/3 eyebrow, myxedema, periorbital puffiness, low HR, possible effusions, decreased LOC, cardiac complications

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3
Q

Myxedema

A

Thickened, shiny skin

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4
Q

Severe form of Hypothyroidism

A

Myxedema coma

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5
Q

Symptoms of myxedema coma

A

low temp, low BP, low RR – acute syndrome

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6
Q

General symptoms of hypothyroidism

A

Hair loss, apathy, lethargy, dry skin, muscle aches, weakness, constipation, cold intolerance, receding hairline, facial & eyelid edema, dull expression, extreme fatigue, thick tongue - slow speech, anorexia, brittle hair & nails, menstrual disturbances

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7
Q

Hypothyroidism treatment

A

Replacement - Levothyroxine (Synthroid)

May also give steroids

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8
Q

Myxedema coma treatment

A

Give T4 IV (can use T3 if T4 ineffective, but check for arrythmias and push slow)

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9
Q

What causes a goiter?

A

Hyperthyroidism

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10
Q

Hyperthyroidism Sx

A

High HR, High BP, rhythm changes (tachy, maybe Afib), insomnia, heat intolerance, wt loss, sweaty, fine hair, incr. bowel movements/diarrhea, enlarged/palpable thyroid, finger clubbing, tremors, menstrual changes, flushing, breast enlargement, muscle wasting, localized edema

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11
Q

Graves Sx

A

goiter, pretibial edema and/or myxedema (swelling of skin and surrounding tissues, exopthalmos (bulging eyes)

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12
Q

Severe form of hyperthyroidism

A

Thyroid Storm

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13
Q

Thyroid storm sx

A

Change in LOC, diarrhea, increased temp, tachy (>140), pounding heart, tremors, shaking, sweating, fever, high SBP (>160), wide pulse pressure

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14
Q

This condition has 50% mortality

A

Thyroid storm

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15
Q

Amiodarone can lead to…

A

Hypo or Hyperthyroidism. Typically normalizes when D/C’d, but may be permanent in some cases.

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16
Q

Primary Hyperthyroidism treatment

A
  • Propranolol - lowers HR and T4/T3 conversion
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17
Q

Secondary Hyperthyroidism treatment

A
  • Propothyouracil (PTU) or methimazole

- both are antithyroid meds used as 1st line tx before ablation of thyroid

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18
Q

3rd line treatment of Hyperthyroidism

A
  • Change diet (increase cals, proteins, and carbs to combat wt. loss and muscle wasting)
  • Radioactive iodine (Cat X, used to diagnose nodules and destroy thyroid tissue)
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19
Q

Radioactive iodine precautions

A
  • Keep distance from pt when possible

- Tell pt to avoid close contact for 3 d after

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20
Q

Thyroid storm tx

A

Beta blocker then PTU wait 1hr, then Iodide then steroids

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21
Q

PTU MOA

A

Is an antithyroid agent which works by stopping the thyroid gland from making thyroid hormone

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22
Q

PTU potential side effects

A

Liver damage

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23
Q

How should PTU be used

A

Typically taken 3 times a day by mouth, may decrease your use of it once your condition is controlled with Dr supervision

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24
Q

Products of the adrenal cortex

A

Glucocorticoids/Mineralcorticoids, Androgens. Cortisol

25
Q

Products of the adrenal medulla

A

Epi and NE

26
Q

A hyperadrenal condition

A

Cushing’s

27
Q

A hypoadrenal condition

A

Addison’s

28
Q

Cushing’s Syndrome Def

A

High cortisol from any cause

29
Q

Cushing’s Disease Def

A

High Cortisol from a pituitary cause or tumor

30
Q

Iatrogenic Cushings Cause

A

Caused by something outside of the body. Most commonly prescribed steroids

31
Q

Ectopic Cushings cause

A

Lung CA can release an ACTH like hormone that causes cushings

32
Q

Hormone precursor of cortisol:

A

ACTH

33
Q

Effects of cortisol on the body

A

Impaired collagen production, enhanced protein catabolism, anti-insulin effect, inhibitory effect on T-cells, enchanced catecholamine activity

34
Q

Cortisol effects these body systems:

A

CV (esp BP), and works on metabolism of fats, carbs, and proteins

35
Q

Cushings Syndrome and disease Sx

A

Central obesity, moon face, buffalo hump, poor wound healing, easy bruising, purple striae on abd, acne, HTN, high glucose, high Na, Low K, psychiatric issues, osteoporosis, HTN (80%), cardiac hypertrophy, purpura, edema (Na retention)

36
Q

Cushings Disease ONLY Sx

A

Hyperpigmentation, masculinization in females

37
Q

What is the cause of the symptoms of Cushings disease

A

Faulty release of melanocyte stimulating hormone during release of increased ACTH

38
Q

Potential cause of impaired immunity, hyperglycema, and poor protein control

A

Cushings

39
Q

Cushings treatment

A
  • reduce corticosteroid use (TAPER)
  • meds prior to surgery to control cortisol
  • Radiation therapy (used with surgery) - pinpoint adrenal gland or adrenal tumor
  • Surgery - tumor removal
40
Q

This tests for cushings

A

Dexamethasone suppression

41
Q

What does a dexamethasone suppression test measure?

A

Whether ACTH secretion by the pituitary can be suppressed

42
Q

How does the dexamethasone test work?

A

Dex is a synthetic steroid similar to cortisol. It reduces ACTH release in normal people so a normal person should have reduced ACTH and cortisol levels following its use. If the pit is producing too much ACTH, the patient may have higher levels of cortisol after the test. Either blood is drawn before and after or urine is collected to evaluate.

43
Q

Most common primary cause of Addison’s in 1st world

A

Autoimmune disorder

44
Q

Most common primary cause of Addison’s in rest of the world

A

Infection

45
Q

Aldosterone is also low in this hypoadrenal condition

A

Addison’s disease

46
Q

Secondary cause of Addison’s

A

Iatrogenic: pts on long term steroids can’t produce their own steroids when stressed or upon abrupt withdrawal

47
Q

How is Addison’s diagnosed?

A

Measure plasma cortisol.

- If low, check plasma ACTH, aldosterone, and renin

48
Q

Lab results of Primary Addisons

A

High ACTH, High Renin, low aldosterone

49
Q

Lab results of Secondary Addisons

A

Low ACTH, Normal Renin/Aldosterone

50
Q

Addisons Sx

A
  • All: wt loss, anorexia, nausea, abd pain

- Low aldosterone (Low Na, High K), hypoglycemia, orthostatis, pigment, changes in hair distribution, weakness

51
Q

Bronzed pigmentation in Addison’s is caused by:

A

High ACTH

52
Q

Severe hypoadrenal condition

A

Addison’s Crisis (fatal if untreated)

53
Q

Addisonian Crisis Sx

A

Severe low BP, Cardiac collapse, Abd pain, Acute Renal Failure, low blood sugar, high levels of potassium –> shock!

54
Q

What are the causes of Addisonian Crisis?

A

Stress, trauma, or infection

55
Q

Addison’s Tx

A
  • All: hormone replacement therapy

- Potential: oral corticosteroids, corticosteroid injections, androgen replacement therapy, sodium

56
Q

This corticosteroid may be used to replace aldosterone

A

Fludrocortisone

57
Q

These corticosteroids may be used to replace cortisol

A

Hydrocortisone, prednisone, or cortisone acetate

58
Q

Increased sodium may be prescribed for Addison’s when…

A

they are in times of stress, such as with operations, infection, minor illness, heavy exercise, hot weather, diarrhea…

59
Q

Treatment of Addisonian Crisis

A
  • Rapid Response worthy

- IV injections of: Hydrocortisone, saline solution, sugar (dextrose)

Nursing 280 (4 decks)

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